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BioTrends Research Group, a research and advisory firm based in Exton, Pennsylvania, finds that nephrologists view diabetic nephropathy as the renal condition with the highest unmet need for treatment, followed closely by acute kidney injury and polycystic kidney disease. The new findings were provided by a recent survey of 105 U.S. physicians (52 nephrologists, 26 endocrinologists, and 27 primary care physicians [PCPs]).

For all physician groups, angiotensin-converting-enzyme (ACE) inhibitors are the most prescribed class of drugs for diabetic nephropathy, followed by angiotensin-receptor blockers (ARBs) and diuretics, while renin inhibitors are used the least. All physician groups use lisinopril, such as Prinvil (Merck) or Zestril (AstraZeneca), more often than other ACE inhibitors. Endocrinologists prescribe ramipril, such as Altace (Pfizer) or Triatec (Sanofi), significantly more often than do nephrologists and PCPs.

“Now that bardoxolone is no longer in development, the focus is on many new clinical compounds in development for diabetic nephropathy, including CTP-499 from Concert Pharmaceuticals or CCX140 from ChemoCentryx, among others,” said analyst Rob Dubman. “However, this study indicates that nephrologists are divided regarding the ideal primary endpoint for a product in clinical development, such as risk of doubling serum creatinine, change in creatinine clearance rate, or GFR, leading to greater complexity for the manufacturers.”